When it comes to knowing whether or not you are working with the right health insurance company there are some red flags to look for before signing on the dotted line. However, it’s not always apparent how well a health insurance company will work for you.
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According to Businessweek there are over 46 million Americans today who are not covered by health insurance. The rise in people without coverage is in direct correlation to the country’s growing unemployment rates.
What are the basic health insurance plans available?
According to the Texas Department of Insurance, there are three basic types of health insurance plans to consider. These are fee for service, managed care and indemnity.
Fee for service plans are straightforward enough. This means you can go to any doctor you choose and the doctor will bill the insurance company for their payment and either have you pay upfront or bill you with your part of the payment. The percentage you pay and your policy pays depends on the plan you get, but you shouldn’t settle for a plan that pays anything less than 50%.
Managed care plans are becoming more and more popular. These are plans where the health insurance company contracts physicians and medical experts to form a network of providers for clients to choose from. The purpose of managed care plans is to avoid major illnesses by using preventative care.
The network of a managed care plan allows doctors and hospitals to charge lower rates to insurance customers and clients as well. They only will pay for services that are necessary and some plans will also cover medications or a list of certain medications.
Indemnity plans allow you to choose your physician or hospital as well, but you’ll have to pay for the services you receive and then file for reimbursement from the insurance company. Your insurance policy could also have stipulations on how much it will pay out for certain services. If you end up being charged more you’ll have to pay the difference out of pocket.
How do I know if I’ve found the wrong provider?
There are some general red flags to look for with health insurance companies. Health insurance fraud is running amuck today, mostly because people are shopping online. There are plenty of companies out there that will take advantage of this and offer the lowest rates without advertising the fine print well.
If you signed with a health insurance company that advertised a largely discounted rate compared to other health insurance companies you should be concerned. In most cases the best health insurance companies will stay within a competitive rate with other great insurance companies.
Some common fraud alerts for health insurance companies to look for are those companies who offer you a policy that would cover preexisting health conditions at a low premium. Finding health insurance with a preexisting health condition is challenging, but finding one with a low premium is unheard of.
The most obvious red flag is when your claims remain unpaid by your health insurance company. This can be frustrating. If you have signed on with a health insurance company that collects your monthly premium but doesn’t pay out anything in claims you may be a victim of fraud.
What if I think my health insurer is fraudulent?
If you find yourself wondering about your health insurance company research their reviews online. It’s always a good idea to check with your state’s department of insurance to see if there have been any complaints made about your health insurance company. The Massachusetts Division of Insurance prides itself in examining the market conduct of insurance companies. This helps to ensure Massachusetts residents don’t get taken advantage of by fraudulent insurance companies.
If you don’t find any information or red flags on your health insurance, but feel they are being fraudulent you should report it to your state’s Division of Insurance. They investigate complaints. If they find fraudulent activity committed by an insurance company, they will prosecute.
Whether or not you get any of your money back depends on the outcome of the court case. You can always take comfort in the fact that you might have saved someone else from being taken advantage of by the same insurance company.
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